Few doctors write most prescriptions for fentanyl

WORKERS' COMP

Published 4:00 am, Saturday, May 7, 2011

Photo: Alan Diaz, Associated Press

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In this April 15, 2011 photo, a protester carries a sign protesting against a pain clinic in Fort Lauderdale, Fla. Florida is the epicenter of the deadly rise in abuse of oxycodone and similar addictive painkillers, with doctors in the Sunshine State prescribing far more of the drugs than all other states combined, according to the Drug Enforcement Administration. And Florida’s pill mills are the supplier of choice for much of the eastern U.S., causing a ripple effect of drug overdoses and addiction tothe north _ a phenomenon dubbed the “OxyContin Express.” less

In this April 15, 2011 photo, a protester carries a sign protesting against a pain clinic in Fort Lauderdale, Fla. Florida is the epicenter of the deadly rise in abuse of oxycodone and similar addictive ... more

Photo: Alan Diaz, Associated Press

Few doctors write most prescriptions for fentanyl

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About 20percent of California workers receiving powerful painkillers for injuries received on the job were prescribed a type of narcotic that is 100 times more potent than morphine, according to a new study that analyzed workers' compensation claims data from 2005 to 2009. Of the patients given those drugs, 11 percent were prescribed medication intended exclusively for end-stage cancer pain. None of those patients had a known cancer diagnosis, according researchers at the California Workers' Compensation Institute.

The findings call into question weaknesses in a system whose primary goal is to return people to their places of work as soon as possible. Instead, these costly and potent drugs, prescribed by a small percentage of doctors, may be delaying patients' recovery and creating a secondary problem of addiction.

"Here we have the most powerful Schedule II drugs available specifically approved for end-stage cancer pain and we're finding them being prescribed and dispensed for routine back injuries," said Alex Swedlow, an author of the report and executive vice president of the Oakland institute, which researches workers' comp issues.

Schedule II drugs, which include oxycodone, fentanyl and methadone, are narcotics that have acceptable medical uses but also a high potential for addiction and abuse. Nearly half these drugs were prescribed for non-surgical back pain.

A study that the institute released in March found that about 3 percent of California workers' compensation doctors were responsible for writing more than half of the prescriptions for Schedule II drugs within the workers' comp system.

The new study, which was released last week, focused on the drug fentanyl, an opioid 100 times more powerful than morphine.

As in the earlier study, the research on fentanyl found that most of the prescriptions were written by a relatively small percentage of doctors. The top 10 percent of doctors who prescribe Schedule II drugs accounted for 84 percent of the fentanyl prescriptions identified in the study.

The study did not identify the doctors. Nor did the researchers speculate on why those doctors prescribed so many of these drugs.

Doctors routinely prescribe drugs for unapproved or "off-label" uses. But experts expressed concern about the possibility that some of them are running "pill mills" and prescribing these drugs inappropriately.

"There are such a small percentage of doctors writing so, so, so many prescriptions. That certainly raises the question whether doctors are orienting their practices around writing prescriptions for workers' compensation patients," said Dr. Jerry Avorn, professor of medicine at Harvard Medical School.

These prescribing patterns are potentially dangerous and expensive, he said. "Besides the problem of addiction, that might be preventable, there's also the cost," Avorn said. "Many patients can be managed perfectly well on either other pain medications that are not narcotics, or generic versions."

Peter Koo, clinical professor of pharmacy and a pain management specialist at UCSF, said lack of physician education in managing pain may be the problem. He said stronger drugs aren't better if they're inappropriate for the patient's pain.

"People use all kinds of pain meds to try to treat the pain, but the pain doesn't always respond to narcotics - specifically if it's a nerve or back pain," he said.

Opioid use

The report, "Prescribing Patterns of Schedule II Opioids Part 2: Fentanyl Prescriptions in California Workers' Compensation," can be found at cwci.org.